The Diabetes Specialist Nurse as Delegated Main Care Provider for Patients With Type 2 Diabetes

Diabetes mellitus type 2 (DM2) is a chronic, progressive illness which causes considerable morbidity and premature mortality.1-2 The worldwide prevalence of DM2 is high and is increasing steadily, also in The Netherlands.3-4 The burden of DM2 on health care has also increased because of the intensified cardiovascular risk management being practiced to prevent macrovascular morbidity and mortality in these patients.5 In the treatment of DM2, tight guidelines are increasingly recommended for optimizing glycaemia, blood pressure and lipid profile.6 Therefore, the burden of treatment has increased and will further increase per patient as well as per population with DM2. In order to meet this problem, we tested, in the current study, the hypothesis that well defined routine aspects in diabetes care, previously handled only by medical doctors in secondary care setting, may be safely transferred to supervised nurses specialized in diabetes (NSD), including the prescription of medication, resulting in at least the same quality of clinical care, health care costs, health related quality of life (HRQOL), and patient satisfaction.

Inclusion criteria

• patients with DM2 who were referred by GPs to the diabetes outpatient clinics

Exclusion criteria

• macroalbuminuria
• serum creatinine level > 135 mol/l,
• Cockcroft < 50 ml/min
• alanine aminotransferase (ALT) > 120 U/l
• pregnant woman